Subcutaneous inejction

Subcutaneous injections:

SubQ is given between the fatty layer of muscle and skin. This is the easiest type of the injection that is given to patient. Insulin is most common medicine given subcutaneously. Other medicines given are growth hormones, epinephrine etc. Medicine, which needs to be delivered slowly over long period of time is given subq. There are certain sites where subcutaneous injections are given. Subcutaneous injection can be given both angle of 90 degree (if we can grasp 2 inch of skin by our thumb) and 45 degrees if we can grasp only 1 inch of skin. Injection procedure: Clean the injection site with alcohol wipe, in the round fashion, begin at the center and then go outward. Allow the alcohol to dry by air or by gauge. Hold the syringe like pen, grasp the skin between the thumb and index finger, quickly thrust the needle into the skin. Release the skin and pull back plunger to check for blood. If no blood appears release the medicine. Pull out the needle and gently press the site by gauge.

Some common abbreviation for medications:

• p.o.: by mouth
• IM: intramuscular injection
• SC: subcutaneous injection
• IV: intravenous
• PR: per rectum
• h.s.: at hour of sleep (bedtime)
• ac: before meals
• pc: after meals
• q: every, ie, q 8 h means every 8 hours
• q.d.: every day
• b.i.d.: twice/day
• t.i.d.: three times/day
• q.i.d.: four times/day
• q.o.d.: every other day

Subcutaneous injection sites

Blood glucose

All the nurses, we test the blood glucose but are lacking proper information about the blood glucose level. We are very unaware of the normal blood glucose level and more ther things. I hope this article would help nurses to have some information about the blood glucose and its complications.

Blood glucose level

Blood Sugar Levels Chart

Type of Person	Fasting Value		Post Prandial
	Min Value	Max Value	Value 2 hours after consuming glucose
Normal	70	100	Less than 140
Early Diabetes	101	126	140 to 200
Established Diabetes	More than 126	-	More than 200

Hypoglycemia: Less than 70 mg/dl. Cause may be missing of meal, excessive exercise, not eating enough carbohydrate. Other clinical cause might include: drug with insulin, liver disease, surgical absence of stomach, tumor releasing excessive insulin, and pre-diabetes. Fasting hypoglycemia (due to fasting) and Reactive hypoglycemia (after meal) is to be considered as well. Signs and symptoms: dizziness, trouble attention, or tingling around mouth. Hypoglycemia makes brain lack of sugar leading to loss of consciousness, seizure, and coma. Severe hypoglycemia can cause death. Treatment: administer of high amount of glucose, medical adjustment, for reactive hypoglycemia take fewer concentrated sweet and multiple small meals throughout the day.

Hyperglycemia: above the 200-240 mg/dl. Fasting hyperglycemia: 90-130. Postprandial: above 180. Cause: skip of insulin, consumption of excessive carbohydrate, (white bread and potato, are broken down to sugar quickly than candy), illness (diabetes 1 and 2), stress. Signs and symptoms: increased urination, excessive thirst, difficulty concentration, blurred vision, And fatigue, weight loss, prolonged: slow healing cuts, decreased vision, nerve damage, chronic constipation, erectile dysfunction. Blood glucose level above 240 can lead to keratoacidosis (blood lack insulin to break down glucose so breaks down fat leading to ketone release, kidney would not be able to remove all the ketone, leading mixing of ketone in blood, leading to diabetic coma and to death). Treatment: check the presence of ketone, if present, avoid exercise as it will increase sugar in blood else. In absence of ketone, immediate exercise, insulin, drink more water, change eating habit, change medication.

Diet; low glucose food: fruits, vegetables, grains, legumes (peanuts, lentils, chickpeas, soy beans, black eyed peas), proteins. High sugar food: carbohydrates.

Different test of sugar: Random test, (can be taken any time, more than 140 prediabetes, more than 200 diabetes, needs other testing). Fasting blood glucose test (at least 8-10 hours fasting), glucose more than 100, prediabetes, more than 125, diabetes). Oral glucose tolerance (done after fasting 10 above, not more than 16 hrs), glucose level is measure. After than given glucose drink, and checks for glucose, first at ½ hour, 1 hr, 1 ½ hr, 2 hr, and 3 hr. 5 times in 3 hr. With normal person, glucose rise and then drops to normal). A1C: glycelated hemoglobin test which measure glucose level averaged over to a 2 to 3 months period. Normal value 4% to 6%. 6%-6.5% prediabetes, 6.5% above diabetes.

Factors affecting glucose level: age, sex, general health, race, medications, alcohol, pregnancy.

If you have any queries or any comment i would love to welcome them

Pyrexia

Pyrexia simply is the higher temperature, above 38 degree Celsius. If fever is above 41.6 degree Celsius is life threatening. Fever in children is caused for the reaction against infection or for the physiological response to illness. The hypothalamus increases the body's temperature as a way to fight the infection. However, many conditions other than infections may cause a fever such as viral infection, bacterial infection, medications, illicit drugs, illness related to heat exposure. Signs and symptoms of fever may be obvious or subtle (the younger the child more subtle it be). In infants signs and symptoms would be, Irritable, fussy, lethargic, quiet, feel warm or hot, not feeding normally, cry, breathe rapidly, exhibit changes in sleeping or eating habits, seizure. Children who can speak may complain of feel of hotness, body aches, headaches, difficulty sleeping, and poor appetite. Parents should take child to hospital in case of not being able to control fever, if child is younger than 6 months, continuous vomiting, or diarrhea, sunken eyes, development of new symptoms. Immediately child has to take to emergency if child has seizure, purple or red rash, alteration in consciousness, breathing swallow, rapid or difficult, continuous headache, and continuous vomiting. Fever itself is not a disease but a physiological response to the disease so diagnosis is required. A diagnosis would require, chest x-ray from sideway and one from front to back, to find out if there is any problem with chest or heart or lung, if child is with cough, or chest pain or shortness of breath. A complete blood count, electrolyte and culture from blood sample will be done. (CBC is done to find out bacterial or viral infection and if immune system is working or not), Electrolyte is done to find out dehydration and electrolyte deficiency. Urine analysis is done to find out infection of urinary tract and dehydration. A lumbar puncture is done to find out CSF, if they suspect meningitis.

Caring of fever is done by given to reduce temperature, prevent dehydration, and monitor serious illness and life-threatening illness. To lower temperature, tapid/sponge bathing can be given (evaporation of water off the skin will lower the temperature), don’t overdress the children (over dressing will prevent cooling from radiation, evaporation, conduction, or convention), best way is leave the child with only one layer of cloth and then cover with bed sheet. Use the medication like acetaminophen (Tylenol, Tempra), and ibuprofen (advil, Mortin) to reduce fever. A warm bath can be given as well but not more than 10 minutes in one hour. To prevent from dehydration, give them enough clear fluid to drink (i.e. chicken soup, pedialyte or other drinks with electrolyte and glucose, not only water). Caffeine containing drink should not be given as it loose water through urination. Monitor for signs and symptoms after lowering and hydrating a child.

Viral infection of the respiratory symptom are most common cause of fever. It is treated with antipyretic and antianalgesic drug. Bed rest and adequate fluid intake is good. Bacterial infection will be treated with antibiotic drug. Urinary tract infection, ear infection, throat infection, sinus infection, skin infection, gastrointestinal infection, and pneumonia may be treated with antibiotic. If child is dehydrated, IV fluids will be given.

Prevention can be done by following general preventive techniques. Hand washing, covering mouth during sneezing, handling food with clean hand, proper immunization, eating healthy diet and getting enough sleep is preventive for fever.

Pneumonia

Pneumonia:

It is the infection of the lungs caused due to the different microorganism ranging from bacteria, virus, fungi and parasite. This is the condition where the alveoli of the lungs swells up or filled with the fluids. As the hollow spaces of the alveoli are filled up with fluids, they tend to be solid and this situation is called consolidation which is mostly not present in viral and mycoplasma infection.

Pathophysiology of pneumonia: Organism invading in the lungs causes the immune system of the body to act. As a result of invading organism, the blood vessels within lungs leaks protein rich fluid to seep into alveoli resulting less area for exchange of the gasses. As patient disrupt the oxygen, the breathing occurs faster so to bring more oxygen and expel carbon dioxide. The mucous production in the pneumonia increased and leaking capillaries may cause the mucous to get tinge of blood. Fluid continues to fill in alveoli and debris resulting from WBC fighting infection also fills the alveoli, resulting in consolidation. This infection causes pyrexia, dyspnea, chest pain, vomiting, abdominal pain, loss of appetite, cyanosis, chills, cough, wheezing sound in cough etc.

Diagnosis: chest x-ray, CBC, mucous culture, blood test.

Treatment: antibiotic according to the organism, antipyretic to reduce fever, antiemetic to control vomiting.

Nursing care: continuous check of fever, vomiting, respiration rate. Inform the physician if the fever is above 39 degree Celsius, vomiting is excessive, respiration rate is more than 40. Encourage fluid intake. Observe cyanosis. Use heating pad or warm compress on the chest area. Personal hygiene. Mouth care. Positioning of patient. Check for oxygen supply if needed.